3 ms·

You're right, MAOIs and tricyclics are usually more effective than any of the newer classes. They also have drastically worse side effects, especially when you

You're right, MAOIs and tricyclics are usually more effective than any of the newer classes. They also have drastically worse side effects, especially when you look at discontinuation rates. We're talking about the difference between making eating cheese extremely dangerous and possibly fatal (some MAOIs) and sexual dysfunction (most SSRIs). That also wasn't what they said: the claim was that antidepressants weren't really effective, not that they haven't really gotten better in the 21st century.

FullMtlAlcoholc 9y ago
> You're right, MAOIs and tricyclics are usually more effective than any of the newer classes. They also have drastically worse side effects, especially when you look at discontinuation rates. We're talking about the difference between making eating cheese extremely dangerous and possibly fatal (some MAOIs) and sexual dysfunction (most SSRIs). You're looking at the older class of MAOIs. Although it is probably a bit overhyped, Selegelline has all the advantages of MAOIs with hardly any of the dietary restrictions. Only those who subsisted on a diet of aged, stinky cheese like Roquefort or otherwise consumed excessive amounts of Tyramine are at risk. You still have to be careful not to take certain medicines, mostly those containing pseudoephedrine. As selegiline is also used as a treatment for parkinson's, it has shown to be neuroprotective, and enhances/induces the differentiation of neural stem cells into neurons (neurogenesis) and is used off label as a nootropic. (Disclaimer: I was taking this prescription until I no longer needed it and saw tremendous results) Modern anti-depressants certainly are more effective than a placebo and have saved many lives. However, I think that a significant % of people would also receive the same or greater results from exercise or mindful meditation. I don't have any numbers in front of me, but anti-depressants are over-prescribed to people who are not clinically depressed but who aren't as happy as they feel they should be. As we glean more results from the various public/private brain research partnerships our undeerstanding should lead to more effective modalities of treatment. How long it takes to get through clinical trials.
jdietrich 9y ago
SSRIs are a much better choice for doctors, but they're not necessarily a better choice for patients. For a doctor, it's a no-brainer to sacrifice a bit of efficacy to avoid the rare catastrophic risks of TCAs or MAOIs. For a patient, the choice may be more nuanced. The side effects of SSRIs aren't particularly dangerous, but they're often very unpleasant.
- johncolanduoni 9y ago
  The common side effects for most TCAs and MAOIs are also much worse than SSRIs, as demonstrated by both incidence rates and (more importantly) discontinuation rates. The second in particular removes doctor choice from the equation.

FullMtlAlcoholc 9y ago

> You're right, MAOIs and tricyclics are usually more effective than any of the newer classes. They also have drastically worse side effects, especially when you look at discontinuation rates. We're talking about the difference between making eating cheese extremely dangerous and possibly fatal (some MAOIs) and sexual dysfunction (most SSRIs). You're looking at the older class of MAOIs. Although it is probably a bit overhyped, Selegelline has all the advantages of MAOIs with hardly any of the dietary restrictions. Only those who subsisted on a diet of aged, stinky cheese like Roquefort or otherwise consumed excessive amounts of Tyramine are at risk. You still have to be careful not to take certain medicines, mostly those containing pseudoephedrine. As selegiline is also used as a treatment for parkinson's, it has shown to be neuroprotective, and enhances/induces the differentiation of neural stem cells into neurons (neurogenesis) and is used off label as a nootropic. (Disclaimer: I was taking this prescription until I no longer needed it and saw tremendous results) Modern anti-depressants certainly are more effective than a placebo and have saved many lives. However, I think that a significant % of people would also receive the same or greater results from exercise or mindful meditation. I don't have any numbers in front of me, but anti-depressants are over-prescribed to people who are not clinically depressed but who aren't as happy as they feel they should be. As we glean more results from the various public/private brain research partnerships our undeerstanding should lead to more effective modalities of treatment. How long it takes to get through clinical trials.

jdietrich 9y ago

SSRIs are a much better choice for doctors, but they're not necessarily a better choice for patients. For a doctor, it's a no-brainer to sacrifice a bit of efficacy to avoid the rare catastrophic risks of TCAs or MAOIs. For a patient, the choice may be more nuanced. The side effects of SSRIs aren't particularly dangerous, but they're often very unpleasant.

johncolanduoni 9y ago
The common side effects for most TCAs and MAOIs are also much worse than SSRIs, as demonstrated by both incidence rates and (more importantly) discontinuation rates. The second in particular removes doctor choice from the equation.